The Big Move: Hospital transfer will be historic undertaking

Aaron Derfel, THE GAZETTE07.22.2014

If everything goes as planned, up to 300 patients will be moved into the McGill University Health Centre superhospital in Notre-Dame-de-Grâce on April 26 next year, marking its official opening.John Mahoney
/ THE GAZETTE

On May 24, more than 150 patients will be transferred from the Montreal Children’s Hospital. Dozens of ambulances will transport patients and a parent or guardian to the new superhospital.John Mahoney
/ THE GAZETTE

Patients from the Montreal Chest Hospital will take part in the last scheduled move to the MUHC superhospital on June 14.Pierre Obendrauf
/ The Gazette

Some clinical activities of the Montreal General Hospital will be moved over to the new superhospital next year.John Mahoney
/ THE GAZETTE

On April 26 next year, the Royal Victoria Hospital will close as many as 300 patients will be transported by ambulance to the city’s first superhospital in Notre-Dame-de-Grâce.Pierre Obendrauf
/ The Gazette

This is the first in a series of stories that will examine the move to the MUHC’s Glen site.

Imagine, if you will, that you’ll be riding in a helicopter on the morning of Sunday, April 26 next year — hovering over the city near the Scottish baronial towers of the Royal Victoria Hospital. What you’ll likely see on that date will no doubt present a unique image in not only Montreal’s history, but all of Canada’s.

From 6 a.m. that morning, you will glimpse a caravan of ambulances — dozens of them — transporting as many as 300 patients to the city’s first superhospital in Notre-Dame-de-Grâce. The patients will include, among many others, those recovering from heart surgery and the frail receiving palliative care in the last days of their lives.

Police will be escorting the ambulances or stopping traffic at intersections to wave them through. Two by two — patient and health-care worker — will be riding in each ambulance as it speeds to its final destination: the vast new hospital of the McGill University Health Centre. It’s an image so epic in scale that it’s not an exaggeration to suggest it recalls God’s creatures boarding Noah’s Ark.

That day, the Royal Vic will close and the superhospital will officially open on a site that used to be the Glen railway yards. It will be one of the first phases of a $10-million multi-site hospital move that will be the biggest and most complex in Canada, challenging the city’s health-care system as never before, as hundreds of elective surgeries and exams will have to be postponed or done elsewhere.

“You’re going to see an ambulance leave the Royal Vic every two minutes,” said Patrick Moriarity, president of Health Care Relocations, the Peterborough, Ont.-based company that has assisted in more than 300 hospital moves around the world and will quarterback the Royal Vic’s.

“It will be a historical undertaking,” Moriarity added. “The patient move will be the pinnacle of all the planning. The Royal Vic has been a hospital for more than 120 years. People have been living and breathing in that building, providing care there for all that time, and in one day, it’s going to go to sleep, and on that same day the Glen (superhospital) will come alive.”

The moves to the MUHC superhospital will include not only the Royal Vic, but the MUHC Research Institute, some clinical activities of the Montreal General, the Montreal Chest and the entire Montreal Children’s — all of this accomplished over a four-month period starting next February. For Health Care Relocations, it will be the biggest such move in Canada and among its top three around the world in terms of logistical intricacy.

The private consortium that’s building the $1.3-billion superhospital — which looks like stacks of giant multi-coloured Lego blocks overlooking the Turcot Interchange — is expected to turn over the facilities to the MUHC on Oct. 1. That turnover will trigger the activation stage, during which more than 300 “early activators” from the MUHC will fan out throughout the building to test and calibrate new medical equipment and run a host of simulations — from a Code Blue (cardiac arrest) to a Code Orange (disaster or mass casualties).

By Oct. 1, the contractor will have to make sure that all the ventilation, air conditioning, heating and plumbing work. But the hospital will be outfitted with many large pieces of new medical equipment — from magnetic resonance imaging machines to linear accelerators for radiotherapy — that the staff need to learn how to operate. In addition, all the beds and chairs need to be checked, along with surgical instruments and mobile equipment like intravenous pumps.

“Every department needs to be prepared in order to become active the very first day that the patients move in,” explained Michèle Verreault-Lortie, the MUHC’s Glen activation project director.

“But we can’t start training early because most people will forget, so we’ll start in February or March, closer to the move.”

A total of 7,500 staff will work in the new facilities, a labyrinthine complex of thousands of rooms spread across the equivalent of several football fields. Hence, the importance of conducting simulations.

“If a kid is coming to the emergency and he’s very sick and he has to go to the OR,” Verreault-Lortie said of one of the scenarios, “what will be the best corridors and elevators for staff to take so that everything can be done very fast?”

In preparation for the move, staff have been told to winnow through their papers, because workers will be allowed only eight linear feet of file space. This “purge,” as Moriarity describes it, is already starting as staff at the existing hospitals go through all their files.

From October until April, groups of workers will visit the superhospital up to five times a day on tours. And when the facilities open in April, representatives from the manufacturers of medical equipment will be on hand to make sure everything works for the first patients — from X-ray machines to CT scanners.

But in February — two months before the first patients move in — the transfer of the Research Institute will begin. An “animal colony” of lab mice and other creatures will be carried into the new Research Institute, with its soaring atrium. The most important priority, however, will be not to spoil any biological specimens in incubators that are part of experiments. Some samples are contained in minus-80 degree freezers.

The MUHC has nearly 200 principal investigators who are spearheading more than 1,900 research projects, seeking to find cures for cancer, diabetes and a host of other diseases.

“We don’t want to adversely affect the integrity of all this research,” Moriarty said.

Ten days in advance of the first patient move at the Royal Vic, the MUHC will purposely slow down by the hundreds its volume of elective surgeries and diagnostic procedures. Some cases will be postponed while other patients might be transferred to other hospitals.

The slowdown is being done in order to deploy staff at the superhospital to get it ready while maintaining essential services at the Royal Vic. It’s a controversial decision, but there really is no other way to carry out the move, Verreault-Lortie suggested.

In the coming months, the MUHC will negotiate with the city for a predesignated route free of construction for the caravan of ambulances to avoid traffic tie-ups.

On April 26, Moriarty’s team at Health Care Relocations will organize the move by using stopwatches and two-way radios. The team has already carried out massive hospital moves in the U.S. — in two instances, after an earthquake and a hurricane.

Elevator repair crews will be on standby at all elevators in case some get stuck — something that has happened in the past, Moriarity said. Hospital staff have been asked not to go on vacation during the moving periods.

Taking a cue from the colour-coded workers on the decks of aircraft carriers, on moving day all the staff will wear different coloured shirts reflecting the tasks they will perform. The “lift teams” — those who will move patients from the bed to stretcher — will be assigned a specific colour. The same will apply to respiratory therapists, doctors and nurses.

Each patient will be accompanied by a health-care worker from their bed at the Royal Vic to the Glen. “From the patient’s standpoint, this is meant to relieve anxiety,” Moriarty said, although he acknowledged some will be anxious.

By mid-afternoon on that date, all the patients will be expected to be relocated in the new facilities. There will undoubtedly be some snags, though. The Royal Vic, for example, has a busy birthing centre. Although it will close before moving, the hospital will have to keep emergency staff in place in case an expectant mother rushes into the emergency room.

On Sunday, May 24, more than 150 patients at the Montreal Children’s will be transferred. This time, the patients will be accompanied not only by a health-care worker but a parent or guardian. The move will prove to be more challenging than the first, because the pediatric charges will arrive in the Children’s pavilion in an already-functioning superhospital full of adult patients.

The final moving day will take place on June 14 for patients at the Montreal Chest and several at the Montreal General. Organizers have saved the easiest move for last.

Although MUHC officials have planned for every contingency, there are many unanswered questions regarding the future care of many patients. That’s because ultimately the redeveloped MUHC — including a renovated Montreal General and the Glen superhospital — will actually contain 107 fewer acute-care beds than what is currently available. By necessity, the MUHC will, over the coming months, redirect a few thousand patients to community hospitals like the Centre hospitalier de Verdun and the Lakeshore.

What’s not clear at this point is whether those hospitals will be given the resources to absorb the influx of patients. And many MUHC outpatient clinics are now grappling with the uncertainty of whether to book appointments for some patients in a year’s time.

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